Improving Nursing Home Performance Through Multi-Pronged Turnaround

Client: A 100-year-old town-owned skilled nursing home (SNF) with 202 licensed beds in Connecticut offering long-term care.

Distinctive Factor: The nursing home was unique in that it was owned by a municipality and operating losses were subsidized by the local government.

Situation: Due to poor management and a payor mix with a disproportionately high Medicaid population, the nursing home faced deteriorating financial conditions, and town officials were seeking to close or sell the historic facility. The facility also had ineffective board membership and leadership, and board members lacked healthcare experience.

Engagement: DRESKIN Advisory’s founder, Ron Dreskin, volunteered to serve on the board, was nominated by the First Selectman and approved at the town’s Representative Town Meeting. Upon appointment, he was elected chairman in recognition of his deep and differentiated healthcare operating expertise.

In addition to serving in Board Advisory and Independent Board Member roles, Dreskin also held an Operating Executive capacity, providing day-to-day oversight. In a two-year term, he conducted a comprehensive assessment of the facility’s operating model and developed a multi-pronged turnaround strategy. Initial actions included strengthening the leadership team through the recruitment of experienced executives, as well as appointing interim management where appropriate. 

Dreskin also identified a structurally unsustainable payor mix driven by long-term residents exhausting personal assets and transitioning to lower-reimbursement Medicaid coverage. To stabilize and improve financial performance, he designed and executed a service-line expansion strategy focused on short-term rehabilitation, typically reimbursed at higher commercial and Medicare rates. Leveraging strategic relationships with nearby health systems, Dreskin facilitated the introduction of new clinical services, reconfigured bed allocation to support short-term stays, and materially increased revenue.

The engagement was further complicated by the facility’s municipal ownership, heightened public oversight, and a disengaged governing board. Dreskin aligned diverse stakeholder groups, navigated complex local governance dynamics, and elevated board effectiveness through education and active leadership, ultimately preserving the facility’s viability and long-term mission.

Outcome:

• Town subsidies reduced by more than 50%, preventing closure

• Financial stability achieved, eliminating the need to sell or close

• A new rehab program was built with a local health system

• Revenue increased, and payor mix improved

• Century-plus legacy assured